D.I.R.

IEP TEMPLATE

XXXXX’s symptoms of his Autism Spectrum Disorder include problems with self regulation,
joint attention and social reciprocity which interfere with learning and with everyday social
emotional function. Fortunately XXXXX is quite able, with facilitation and support, to be calm
and regulated, and to work together in sharing and building ideas. To accomplish this, I
recommend that the I.E.P. team adopt the following social-emotional goals that reflect in a
straightforward manner XXXXX’s basic difficulties so that these may be addressed:

1. Self-Regulation:

• Baseline: XXXXX is calm and focused __% of the time during any given 15
minute observation in class (“C”), __% during unstructured activities such as
recess and lunch (“US”).
• October 2006 Goal: __% C/ __% US.
• March 2007 Goal: __% C/ __% US
• June 2007 Goal: __% C/ __% US
• Responsible persons: teacher, staff, OT
• Suggested interventions and accommodations: OT consultation monthly, sensory
diet and strategies for home and school, staff facilitation of interactions with
peers including during unstructured times, typical ADHD accommodations.

2. Rigid Thinking/ Shared Attention:

• Baseline: XXXXX is on the ‘same page’ as others about __% of the time during a
given 15 minute observation in class (“C”) and about __% of the time during
unstructured time (“US”).
• October 2006 Goal: __% C/ __% US
• March 2007 Goal: __% C/ __% US
• June 2007 Goal: __% C/ __% US
• Responsible persons: teacher, staff, counselor (DIS)
• Suggested interventions and accommodations: social skills group, facilitation of
interactions in class and at lunch and on the playground, typical ADHD type
interventions such as non-verbal prompts.

3. Sharing Ideas/ Social Reciprocity:

• Baseline: XXXXX tends to focus in his own ideas in play and conversations, and
engages in actual mutual building of ideas about __% of the time during any
given 15 minute period while in class (“C”) and __% during unstructured time
(“US”).
• This can be assessed by examining a 15 minute sample of conversation and
scoring the percentage of times that XXXXX’s initiation or responses take into
account and/ or respond to other people present. Tape recordings or videotape
may be needed to best assess this, although it can be done by observation as well.
I am happy of assist in the training of persons to do this.
 • October 2006 Goal: __% C/ __% US.
• March 2007 Goal: __% C/ __% US
• June 2007 Goal: __% C/ __% US
• Responsible persons: teacher, staff, counselor (DIS).
• Suggested accommodations and interventions: social skills group, staff
facilitation in class, at lunch, and on the playground.

In summary, if we ask ourselves, in order, whether XXXXX is: a) calm and focused; b) on the
same page; and c) is he working with together with other people or more focused on his own
ideas, we will naturally be in position to facilitate XXXXX’s social-emotional function. It is
likely that his improvement will be easier in class, and with adult, but it is truly critical that he
improve in unstructured settings with peers.